Guidelines on Withholding Medical Treatment Lawful

The Court of Appeal, in a long-awaited decision, has agreed that guidance issued by the General Medical Council, as to when life-prolonging treatment in the form of hydration and artificial nutrition can be withdrawn, is lawful and not in contravention of a patient’s rights under the European Convention of Human Rights.

The case had been brought on behalf of Mr Leslie Burke, who suffers from a congenital and progressive neural condition. Wheelchair user Mr Burke was seeking to ensure that his life will be prolonged as long as possible. He anticipates being mentally competent until the final stages of his life but was concerned that his expected inability to communicate might at that time result in artificial nutrition and hydration being withdrawn, thus hastening his death.

The Court disagreed with his interpretation of the guidelines, which in the view of the Justices of Appeal did not mean that nutrition and hydration could be removed contrary to the patient’s wishes.

In a lengthy judgment, considering the position of terminally ill patients generally, the Court confirmed that where a competent patient has made it clear that they do not wish to receive treatment that is, in an objective sense, in their best interests, it is unlawful to administer such treatment. In normal circumstances, however, it is the duty of medical staff caring for a patient to try to keep the patient alive, which will, where appropriate, require them to give artificial nutrition and hydration unless the patient is competent and refuses such treatment. However, where the patient is not competent, the situation is more difficult, since it is not possible to define objectively what is in a patient’s best interests on the basis of a single test.